{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:06:59Z","timestamp":1793074019651,"version":"4.5.0"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index \u22640.90).<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N\u2009=\u2009370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N\u2009=\u2009349).<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0;\n P<\/jats:italic>\n \u2009=\u2009.02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, \u2212192.9 to \u221272.1;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.34590","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T11:01:42Z","timestamp":1695294102000},"page":"e2334590","source":"Crossref","is-referenced-by-count":35,"title":["Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease"],"prefix":"10.1001","volume":"6","author":[{"given":"Neela D.","family":"Thangada","sequence":"first","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongxue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Health Research and Policy, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Jack","family":"Rejeski","sequence":"additional","affiliation":[{"name":"Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen J.","family":"Ho","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Ferrucci","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute on Aging, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Spring","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina R.","family":"Kibbe","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia School of Medicine, Charlottesville"},{"name":"Editor, JAMA Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar S.","family":"Polonsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical School, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Criqui","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health University of California San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary M.","family":"McDermott","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois"},{"name":"Deputy Editor, JAMA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"issue":"12","key":"zoi230994r1","doi-asserted-by":"publisher","first-page":"e686","DOI":"10.1161\/CIR.0000000000000470","article-title":"2016 AHA\/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"135","author":"Gerhard-Herman","year":"2017","journal-title":"Circulation"},{"issue":"21","key":"zoi230994r2","doi-asserted-by":"publisher","first-page":"2188","DOI":"10.1001\/jama.2021.2126","article-title":"Lower extremity peripheral artery disease without chronic limb-threatening ischemia: a review.","volume":"325","author":"Polonsky","year":"2021","journal-title":"JAMA"},{"issue":"14","key":"zoi230994r3","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1001\/jama.2022.2457","article-title":"Home-based walking exercise for peripheral artery disease.","volume":"327","author":"McDermott","year":"2022","journal-title":"JAMA"},{"issue":"8","key":"zoi230994r4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.007953","article-title":"Supervised exercise therapy for symptomatic peripheral artery disease among Medicare beneficiaries between 2017 and 2018: participation rates and outcomes.","volume":"14","author":"Divakaran","year":"2021","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"1","key":"zoi230994r5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1161\/CIRCULATIONAHA.114.007002","article-title":"Six-minute walk is a better outcome measure than treadmill walking tests in therapeutic trials of patients with peripheral artery disease.","volume":"130","author":"McDermott","year":"2014","journal-title":"Circulation"},{"issue":"5","key":"zoi230994r6","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001107","article-title":"Step-monitored home exercise improves ambulation, vascular function, and inflammation in symptomatic patients with peripheral artery disease: a randomized controlled trial.","volume":"3","author":"Gardner","year":"2014","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"zoi230994r7","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1001\/jama.2008.962","article-title":"Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial.","volume":"301","author":"McDermott","year":"2009","journal-title":"JAMA"},{"issue":"21","key":"zoi230994r8","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1001\/jama.2017.17437","article-title":"Effect of granulocyte-macrophage colony-stimulating factor with or without supervised exercise on walking performance in patients with peripheral artery disease: The PROPEL randomized clinical trial.","volume":"318","author":"McDermott","year":"2017","journal-title":"JAMA"},{"issue":"13","key":"zoi230994r9","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1001\/jama.2022.16797","article-title":"Effect of telmisartan on walking performance in patients with lower extremity peripheral artery disease: The TELEX randomized clinical trial.","volume":"328","author":"McDermott","year":"2022","journal-title":"JAMA"},{"issue":"1","key":"zoi230994r10","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1001\/jama.2013.7231","article-title":"Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial.","volume":"310","author":"McDermott","year":"2013","journal-title":"JAMA"},{"issue":"13","key":"zoi230994r11","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1001\/jama.2021.2536","article-title":"Effect of low-intensity vs high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease: The LITE randomized clinical trial.","volume":"325","author":"McDermott","year":"2021","journal-title":"JAMA"},{"issue":"16","key":"zoi230994r12","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1001\/jama.2018.3275","article-title":"Effect of a home-based exercise intervention of wearable technology and telephone coaching on walking performance in peripheral artery disease: The HONOR randomized clinical trial.","volume":"319","author":"McDermott","year":"2018","journal-title":"JAMA"},{"issue":"3","key":"zoi230994r13","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/S1078-5884(97)80102-5","article-title":"A comparative study of treadmill tests and heel raising exercise for peripheral arterial disease.","volume":"13","author":"Amirhamzeh","year":"1997","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"4","key":"zoi230994r14","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1177\/1358863X18762599","article-title":"Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease.","volume":"23","author":"Gardner","year":"2018","journal-title":"Vasc Med"},{"issue":"1","key":"zoi230994r15","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.jvs.2020.03.052","article-title":"Meaningful change in 6-minute walk in people with peripheral artery disease.","volume":"73","author":"McDermott","year":"2021","journal-title":"J Vasc Surg"},{"issue":"4","key":"zoi230994r16","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1249\/00005768-199104000-00003","article-title":"Progressive vs single-stage treadmill tests for evaluation of claudication.","volume":"23","author":"Gardner","year":"1991","journal-title":"Med Sci Sports Exerc"},{"issue":"3","key":"zoi230994r17","first-page":"142","article-title":"Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease.","volume":"2","author":"Regensteiner","year":"1990","journal-title":"J Vasc Med Biol"},{"issue":"12","key":"zoi230994r18","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017609","article-title":"Perceived vs objective change in walking ability in peripheral artery disease: results from three randomized clinical trials of exercise therapy.","volume":"10","author":"McDermott","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"6","key":"zoi230994r19","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.ahj.2015.03.009","article-title":"Supervised vs unsupervised exercise for intermittent claudication: a systematic review and meta-analysis.","volume":"169","author":"Vemulapalli","year":"2015","journal-title":"Am Heart J"},{"issue":"4","key":"zoi230994r20","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1002\/bjs.11101","article-title":"Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease.","volume":"106","author":"Golledge","year":"2019","journal-title":"Br J Surg"},{"issue":"2","key":"zoi230994r21","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.jvs.2022.09.014","article-title":"Barriers to participation in supervised exercise therapy reported by people with peripheral artery disease.","volume":"77","author":"Cetlin","year":"2023","journal-title":"J Vasc Surg"},{"issue":"5","key":"zoi230994r22","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1016\/j.jvs.2019.08.238","article-title":"National assessment of availability, awareness, and utilization of supervised exercise therapy for peripheral artery disease patients with intermittent claudication.","volume":"71","author":"Dua","year":"2020","journal-title":"J Vasc Surg"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2809783\/thangada_2023_oi_230994_1694794702.30501.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T11:01:47Z","timestamp":1695294107000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2809783"}},"subtitle":["An Individual Participant Data Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,5]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.34590","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,21]]}}}